SHP Provider Contracting Consult-Senior

JOB SUMMARY/PURPOSE

Responsible for leading complex, high-value provider contracting initiatives across Medicaid, Medicare Advantage, and Commercial lines of business. Participates in the development of and executes multi-year contracting strategies for hospitals, health systems, large physician organizations, and other strategic providers. Serves as a subject matter expert in reimbursement methodologies, value-based payment design, and regulatory compliance. Leads high-stakes negotiations, performs advanced financial modeling, advises executive leadership on network strategy, and mentors contracting staff. Exercises broad discretion within delegated authority and significantly influences organizational cost-of-care, network adequacy, and quality performance outcomes.

DEPARTMENT DESCRIPTION

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

EXPERIENCE/EDUCATION/QUALIFICATIONS

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field, or equivalent related experience required.
• Four (4) years of progressive provider contracting experience in a managed care environment required.
• Experience negotiating complex hospital, health system, and risk-based agreements required.
• Experience across Medicaid, Medicare Advantage, and Commercial product lines required.
• Extensive experience designing and managing value-based payment and alternative payment models required.

KNOWLEDGE/SKILLS/ABILITIES

• Deep understanding of federal and state regulatory requirements. Expert-level knowledge of healthcare reimbursement methodologies (DRG/IPPS, OPPS, capitation, percent-of-Medicare, bundled payments, risk arrangements).
• Advanced financial modeling and analytical skills (expert-level Excel proficiency required).
• Ability to manage multiple high-priority initiatives simultaneously. Exceptional negotiation, influence, and conflict resolution skills.
• Strong executive presence and ability to communicate complex financial concepts to senior leadership.
• Strategic thinker with strong business and market acumen.
• Proven leadership and mentoring capability.

PHYSICAL DEMANDS

Rarely
(1 - 10% of the time)
Occasionally
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 – 100% of the time)